PSY 254 Chapter 13 - Schizophrenia Spectrum and Other Psychotic Disorders

What are the 5 types of psychotic disorders the DSM-5-TR lists?

• Schizophrenia

• Schizophreniform Disorder

• Brief Psychotic Disorder

• Schizoaffective Disorder

• Delusional Disorder

What are the symptoms of schizophrenia?

• No single symptom of specific set of symptoms

• Most common symptoms: changes in the way a person thinks, feels, and relates to other people and the outside environment

Is schizophrenia divided into subtypes?

No

What were the previous subtypes for schizophrenia?

• catatonic

• disorganized

• paranoid

• residual

• undifferentiated

What are the three major clusters of symptoms for people with schizophrenia?

• positive (psychotic)

• negative symptoms

• disorganization

What are positive (psychotic) symptoms?

presence of abnormal functioning

what are the positive (psychotic) symptoms

• hallucinations

• delusional beliefs

what are hallucinations?

sensory experiences in the absence of sensory stimulation; perceptual disturbances. they can occur in any of the sense and are persistent overtime

what are the types of hallucinations?

• Auditory

• Visual

What are auditory hallucinations?

They are the most common and include things like hearing voices

What are visual hallucinations?

seeing violent or sexual images; seeing people who are not there

what are delusional beliefs?

firmly held beliefs that are contrary to reality and are resistant to disconfirming evidence

what are the types of delusions?

• persecutory delusions

• thought insertion

• thought broadcasting

• outside control

• grandiose delusions

what are persecutory delusions?

beliefs that one is being targeted or harmed by others

what is thought insertion?

the belief that thoughts are being placed into one's mind by external forces

what is thought broadcasting?

the belief that one's thoughts are being transmitted to others.

what is outside control?

the belief that one's thoughts or actions are being controlled by external forces.

what are grandiose delusions?

The belief that one has exceptional abilities, wealth, or fame beyond what is realistically true.

what are negative symptoms?

absence of normal functioning

what are the negative symptoms?

• avolition

• asociality

• anhedonia

• blunted affect

• alogia

what is abolition?

lack of interest; apathy

what is asociality?

inability to form close personal relationships

what is anhedonia?

inability to experience pleasure

what is the blunted affect?

exhibits little or no affect in face or voice

what is alogia?

reduction in speech?

what are disorganized symptoms?

verbal communication problems and bizarre behavior

what are the disorganized symptoms?

• disorganized speech

• disorganized behavior

• catatonic behavior

• waxy flexibility

what is disorganized speech?

involves saying things that do not make sense; irrelevant responses to questions, disconnected ideas, using words in peculiar ways

• tangentiality

• incoherence

• loose associations

• perseveration

what is tangentiality?

irrelevant responses

what is incoherence?

inability to organize ideas

what are loose associations?

shifting topics too abruptly

what is perseveration?

persistently repeating the same word or phrase over and over

what is disorganized behavior?

odd or peculiar behavior, such as: silliness, agitation, unusual dress

what is catatonic behavior?

motor abnormalities

what are symptoms of catatonic behavior?

• immobility and muscular rigidity

• excitement and overactivity

• also associated with being in a stupor and reduced responsiveness

what is waxy flexibility?

limbs can be manipulated and posed by another person

What are the 3 symptom phases of schizophrenia?

• prodromal phase

• active phase

• residual phase

what is the prodromal phase?

obvious deterioration in functioning, change in personality including peculiar behaviors and perceptual experiences

what is the active phase?

symptoms such as hallucinations, delusions, and disorganized speech are present

what is residual phase?

signs and symptoms may improve, but negative symptoms and impairment often continue

What is schizophreniform disorder?

• same symptoms as schizophrenia

• symptoms duration: greater than 1 month but less than 6 months

• symptoms must include either hallucinations, delusions, or disorganized speech

what is brief psychotic disorder?

• symptom duration 1 day to 1 month

• Often triggered by extreme stress, such as bereavement

• Symptoms must include either hallucinations, delusions, or disorganized speech

  • Not all the same symptoms; duration is brief

what is schizoaffective disorder?

• symptoms of both schizophrenia and either a depressive or manic episode

• symptoms of a major mood episode are present for a majority of the duration of the illness

what is delusional disorder?

preoccupation for at least 1 month with delusions that are not bizarre

what are some types of delusions in delusional disorder?

• persecution

• jealousy

• being followed

• erotomania

• somatic delusions

what is erotomania?

loved by a famous person

What is the lifetime prevalence of schizophrenia?

about 1 percent

When does schizophrenia typically begin?

Typically begins during adolescence or early adulthood

What is the period of risk for the development of a 1st episode?

between the ages of 15 and 35

Are men or women more likely to develop schizophrenia?

men are about 30-40% more likely

Who is more likely to experience negative symptoms?

males

who does early onset schizophrenia affect more?

males

who does later onset schizophrenia affect more?

women

What is the cross-cultural frequency of schizophrenia?

8 to 43 cases for every 100,000 people

What are the biological causes of schizophrenia?

• Genetics

• Pregnancy and Birth

• Dopamine Theory

• Brain Structure

How do genetics play a role in schizophrenia?

Genetics contribute to schizophrenia by increasing the likelihood of developing the disorder based on family history and heritable factors. Studies show a higher risk for individuals with a close relative diagnosed with schizophrenia. Negative symptoms have stronger genetic component

What do pregnancy and birth have to do with schizophrenia?

• People with schizophrenia are more likely to have been exposed to various problems during their mother’s pregnancy and to have suffered birth injuries

• Dietary factors - severe maternal malnutrition

• More likely to be born in the winter (viral infections more likely during this time of the year)

  • Topic of debate between researchers

What is dopamine theory?

disorder due to problems with dopamine

What is the significance of dopamine theory in schizophrenia?

• Medications that typically reduce symptoms work by reducing dopamine activity

• Theory doesn’t completely explain disorder - medications don’t work as quickly as they should, reduce dopamine to below normal levels

What role does brain structure play in schizophrenia?

A number of brain areas, and connections among areas, are involved in schizophrenia

What brain structures are affected schizophrenia?

• decrease in brain tissue total volume

• Mildly to moderately enlarged lateral ventricles

• Decreased size of hippocampus, amygdala and thalamus

• Dysfunction in various neural circuits in some regions of prefrontal cortex, regions of temporal lobes

What are the psychological factors of schizophrenia?

• Family environment

What role does family environment play on schizophrenia?

• Blame used to be placed on "schizophrenogenic mother" - cold, domineering, conflict-inducing  

  • No support for this theory  

• Family environment does have a significant impact on the course (as opposed to the etiology) of schizophrenia  

  • Relapse is associated with family patterns of interaction characterized by high levels of expressed emotion (EE)  

    • Negative or intrusive attitudes and behavior toward the patient  

What are the social factors of schizophrenia?

SES (socioeconomic status)

what role does SES play in schizophrenia?

• Highest rates are among urban poor

• Social Causation Hypothesis

• Social Selection Hypothesis

What is social causation hypothesis?

social class hardships cause schizophrenia

what is social selection hypothesis?

people with schizophrenia gradually fall into lower social classes

What are medication treatments?

• Antipsychotic medications (1st generation)

• Antipsychotic Medications (2nd generation)

What are 1st generation antipsychotics?

• Reduce psychotic symptoms only, with little effect on negative symptoms

• Usually takes 2 - 3 weeks before improved

  • Some patients do not improve

• Can have significant and detrimental side effects

What are some examples of 1st generation antipsychotic medication?

• Thorazine

• Haldol

• Navane

What are the side effects of 1st generation antipsychotics?

• Extrapyramidal Symptoms (EPS)

• Tardive Dyskinesia (TDS)

What is extrapyramidal symptoms (EPS)?

• Muscular rigidity, tremors, restless agitation, peculiar involuntary postures, and motor inertia

• EPS may diminish spontaneously after 3-4 months of continuous treatment

What is tar dive dyskinesia?

• Syndrome consists of abnormal involuntary movements of the mouth and face

  • Tongue protrusion, chewing, and lip puckering; spasmodic movements of the limbs and trunk of the body

• Duration of TDS varies; symptoms can be reversed with medication stoppage or some may be more long lasting

What are 2nd generation antipsychotics?

• As effective as typically antipsychotics for treatment of positive symptoms

  • Not more effective for negative symptoms

• Fewer motor side effects

• Less treatment noncompliance

What are examples of 2nd generation antipsychotic medications?

• Seroquel

• Risperdal

• Zyprexa

What are other treatments?

• Family-Oriented Therapy

• Social Skills training

• Cognitive Therapy

• Community-Based Treatment

• Institutional Programs

What is family-oriented therapy?

• Attempts to improve the coping skills of family members

• Includes an educational component

• Emphasis on improving communication and problem-solving

• Stress importance of medication

• Help family avoid blaming patient

• Encourage expanded support networks

• Instill hope

What is social skills training?

• Structured, educational approach that involves modeling, role-playing, and social reinforcement

• Teach skills for managing interpersonal situations

• Teach skills for managing active of daily living (ADLs)

  • Completing a job application

  • Reading bus schedules

  • Make appointments

What is cognitive therapy?

• Recognize and challenge delusional beliefs

• Recognize and challenge expectations associated with negative symptoms

  • Ex. "Nothing will make me feel better so why bother?”

• Other treatments focused on: improving attention, memory, problem-solving and other cognitive-based symptoms

What is Community-Based Treatment?

• Focus is on providing an array of psychological interventions and medication on a regular/continuous basis in the community

  • Delivered by interdisciplinary team including case management

  • Can include vocational rehabilitation services and clubhouses

• Studies suggest it is effective in reducing inpatient hospital days and, despite its expense, it is cost-effective

What are institutional programs?

• Hospitalization (possibly at least 2-3 weeks) is often needs for acute psychosis

  • Not used as a residential setting/permanency plan like in past

  • Instead used as intervention to stabilize patient, increase their safety, and often adjust their medications